MEDICARE: DOUGLAS W BOUCHEY RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302023892	MI
2	183500000X	Pharmacist	13803-040	WI

General Provider Information

NPI Number	:	1700010667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS W BOUCHEY RPH

Provider Business Mailing Address
First Line	:	1905 CHURCHILL BLVD
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-9100
Country	:	US
Telephone Number	:	989-775-0828
Fax Number	:	989-775-0828

Provider Business Practice Location Address
First Line	:	352 N ROSS ST
Second Line	:
City	:	BEAVERTON
State	:	MI
Zip	:	48612-8165
Country	:	US
Telephone Number	:	989-435-7727
Fax Number	:	989-435-3779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2009
Last Update Date	:	05/06/2009

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Directions to “ DOUGLAS W BOUCHEY RPH” Practice Location

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